I’ve spent nearly thirteen years working in frontline mental health services, seven of those as a registered nurse. In all that time, I’ve seen thousands of patients, and spent thousands of hours in hospitals, assessment rooms, the community, and even working from the kitchen during lockdown.
In all that time, I’ve seen politician after politician talk about ‘parity of esteem’ for mental health services, about new money, recycled money, extra revenue coming in, new hospitals, more beds, more GPs, more nurses, more appointments, more… everything.
And in all that time, all those promises have been empty.
As national budgets are slashed in the name of austerity, I see three fronts that suffer:
First, with the most self-interest, is the issue of pay for healthcare workers. Nurses, like so many public sector workers, have endured years of pay ‘restraint’ since the financial crisis of 2008 – and it’s not like we were overpaid before that! The failure of the banks wasn’t a problem we created, but it was one we were expected to pay for. If you were a Band 5 nurse in 2010, you will have seen your take-home pay shrink by a third in real terms – around £11,000 a year. Small rises came, but each was more than cancelled out by inflation, higher pension payments and bigger bills. Even this year, we were ‘awarded’ 3 per cent, paid in September and backdated to April. Every nurse I know, myself included, expected a small windfall of a few hundred pounds, enough that we might not worry so much about our gas and electric bills doubling. In fact, most of us were worse off, as the ‘pay rise’ was consumed by increased deductions. We were all worse off.
Every time executive pay gets talked about, they justify huge salaries and huge bonuses as the only way to get good people into those jobs. If pay and conditions are how you let people know what they are worth, retain talent, and encourage recruitment, then nurses know that we aren’t valuable to this government. In a recent interview, Health Minister at the time Therese Coffey said: “Nurses can leave if they want to” – a contemptuous, demeaning and frankly stupid comment. It’s no wonder that my colleagues are leaving in record numbers, and no wonder that we struggle to recruit into our industry. There are 45,000 nurse vacancies in England and Wales right now.
The second front that suffers is essential services due to cuts. Mental Health services have seen cuts to 15,000 beds and over 12,000 nursing posts since 2009 – we have to do more with less. As it was we had a mountain to climb, but successive governments have taken away our boots, our packs, our walking sticks…
It’s not just cuts to health services either, public health spending has dropped by at least a quarter in real terms, which means prevention of illness is being abandoned for short-term penny-pinching. Social care is hundreds of millions of pounds worse off, and like nursing is in the depths of a severe recruitment crisis. Stresses induced by A*-obsessed schools risk severe and enduring emotional damage. Cuts to vital programmes like the obesity strategy, transport, nutrition, housing, community centres and many, many more have enormous knock-on effects.
That leads me to point three: I used to see patients who were suicidal because they were having a psychotic crisis or severe depression. Now I see patients who are suicidal because they can’t heat their homes or feed their children. Poor housing, poor prospects, and poor jobs all make life more difficult and increase distress. Health is affected by poor access to nutritious food and a lack of places to exercise. Run-down high streets with cheap takeaways and gambling shops increase the likelihood of a poor lifestyle. The 2010 Marmot Review (and its 2020 update) talk about ‘deaths of despair’, where there’s little to no prospect of improvement and so people essentially give up on life. The increasing inequality in the UK isn’t just making the rich richer. The most vulnerable in society are suffering more acutely now than ever.
The recent chaos in the Westminster government that cost billions to the economy has guaranteed that all the services we rely on are going to face significant cuts. We are on course for Austerity 2.0, an unwelcome and unwarranted return of a deeply damaging policy. The first round of austerity demonstrably cost thousands of lives – every serious analysis supports this conclusion – with the suffering greatest for those least able to bear it. As services struggle further, as need is greater than ever, as costs soar and social exclusion increases, we can see that the ideological cuts are going to cause yet more harm.
As the UK government totters between leaders, uncertainty, upheaval and chaos increase the chances that the most left-behind people will fail to get the progress they so desperately need. There is very little hope for improvement that I can offer my patients or my colleagues. I would love to close on a positive note, but from my perspective, there's no chance of a change for the better until our government is gone